Background

Data on efficacy and safety of inflammatory bowel disease (IBD) treament in the elderly is sparse as they are often excluded from clinical trials. We aimed to analyse treatment options and adverse events in elderly IBD patients.

Methods

Retrospective study including 345 IBD patients followed in our outpatient clinic from January 2008 to October 2016. Demographic and clinical data was analysed. Eldery was defined as patients over 60 years of age.

Results

173 (50.1%) Crohn's disease, 168 (48.7%) Ulcerative colitis and 4 (1.2%) Indetermined colitis patients were included, 56.2% were female and the median follow—up was 13 years (IQR 8–19). Mean age at diagnosis was 33.0 years (IQR 23.0–45.5), 36 (10.4%) patients had elderly-onset IBD and 106 (30.7) were ≥60 years at the time of the study analysis. Charlson comorbidity index (4.1±1.4 vs. 0.8±1.3, p<0.001) and total number of daily medications (4.3±3.5 vs. 1.6±1.6, p<0.001) were significantly higher in patients ≥60 years. This group received more frequently sulfasalazine or 5-aminossalicylates (84.6% vs. 72.0%, p=0.001) and less frequently azathioprine (19.8% vs. 51.5%, p=0.000) or tumor necrosis factor inhibitors (13.2% vs. 36.0%, p=0.000). There was no significant difference concerning the use of metotrexate or surgery. When comparing elderly with non-elderly, global incidence of adverse events was not significantly different (16.0% vs. 21.3%, p=0.253), neither was the sub-analysis of patients under sulfasalazine or 5-aminossalicylates (p=0.233), azathioprine or 6-mecaptopurine (p=0.786) or tumor necrosis factor inhibitors (p=0.549). Infection was not more frequently diagnosed in the elderly (p=0.784).

Conclusion

One in each 10 patients has elderly-onset IBD. Although immunosuppression was used less frequently in this population, there was no significant differences in its safety profile.